Not knowing where your food will come from, where you will live, or if there will be heat in your home day to day or week to week can certainly be stressful for anyone. But, according to new research published this week in the journal Pediatrics, the cumulative effect of these hardships can be detrimental to children’s health. The impact of a “weathering effect” as it is referred to by some researchers, was explored by researchers from Boston Medical Center and Children’s HealthWatch. Their analysis included 7,141 children between four months- and three-years-old who were evaluated while waiting for medical care at five different primary-care clinics or emergency rooms in Boston, Little Rock, Baltimore, Minneapolis and Philadelphia. Researchers found that, children who experienced multiple poverty-related hardships had significantly worse health outcomes, as determined by overall measures of wellness.

In inquiries about consistency of housing, heat and food, researchers rated hardship on a scale of 0-6, where security in housing, food or heat was given a 0, some insecurity in any of these categories was marked as 1, and significant insecurity was marked as 2. A score of 0 signified no hardship, 1-3, moderate hardship, and 4-6, severe hardship. The researchers found that, while 37% of children faced no hardship, 57% faced moderate hardship, and 6% encountered severe hardship. Among children who had to deal with more instability and difficulty, wellness—a measurement that included caregivers assessment of overall health, medical records and hospitalizations, among other things—was significantly worse. While 46% of children who faced no hardship met wellness criteria, 42% facing moderate hardship and 35% enduring severe hardship did.

The study authors conclude that: “Food insecurity, housing insecurity, and energy insecurity, which are potentially remediable, adverse material conditions that are pervasive among low-income families in the United States, are in concert associated negatively with wellness among infants and toddlers.” The cumulative impact of hardships can have compounding negative physiological effects, the researchers argue, by influencing diet, warmth, exposure to disease and other factors. “… [S]evere hardship had a significantly greater impact than moderate hardship, which had a significantly greater impact than no hardship,” they write.

The current findings, the researchers argue, point to a need for public health programs that target individual hardships or work to “mitigate their impact on children,” as well as a need for pediatricians and primary care givers to consider the many factors that may be contributing to their patients’ overall health when attempting to design the most effective treatments, and plans for prevention.

Read the Children’s HealthWatch press release and download the full study here.